Women's Heart Guidelines

Feb. 20, 2007 -- Heart disease kills 1 in 3 American women, but it doesn'thave to be that way.

Women can prevent heart disease and stroke, show the latest guidelines fromthe American Heart Association.

Armed with new data -- and encouraged by the fact that 60% of U.S. women nowknow that heart disease is their No. 1 health threat -- the AHA has launched anambitious prevention program.

The program is the work of an expert panel led by Lori Mosca, MD, MPH,director of preventive cardiology at New York-Presbyterian Hospital and of theColumbia University Center for Heart Disease Prevention.

"Women are still confused about cardiovascular disease prevention,"Mosca said at a news conference. "We hope to clear up some of thisconfusion. These new guidelines will help our patients ... develop strategiesto combat this leading killer."

Cardiovascular disease refers to any disease that affects the heart andblood vessels, including stroke.

The AHA women's heart disease prevention strategy has three main elements:living a healthy lifestyle, addressing major heart risk factors, and usingappropriate medications.

Here's the plan:

All women age 20 and older should see a doctor to find out their heartdisease risk.

About one in 10 women will learn she is at "optimal risk," meaningshe's currently at no real risk of heart disease. These women should continuetheir heart-healthy lifestyles.

Most women will be "at risk" -- meaning they must start thinkingabout preventing heart disease and stroke. These women must stop smoking, adopta heart-healthy diet, get at least 30 minutes a day of exercise, and watchtheir weight. With a doctor's advice -- and only with a doctor's advice -- someof these women may need blood pressure medications, cholesterol-loweringtherapy, or regular aspirin.

Many women will be "high risk," meaning they already have somecondition that makes it particularly likely they will suffer heart disease orstroke. In addition to taking the measures advised for their "at risk"sisters, "high risk" women may need more aggressive medical treatmentsor rehab.

Depression is common in women with heart disease. All women with heartdisease should be evaluated for depression.

The new guidelines appear in the March 13 issue of the AHA journalCirculation.

Heart Disease in Women

These guidelines replace the AHA's 2004 guidelines with even more aggressiveexercise and diet rules.

"All women should exercise a minimum of 30 minutes a day," Moscasaid. For women who want to lose weight, Mosca and colleagues recommend 60 to90 minutes of exercise "most, or preferably all, days of the week."

As for diet:

Fruits and vegetables, whole grains, high-fiber foods, and oily fish shouldmake up the biggest part of a woman's diet.

Saturated fats should be no more than 10% of energy intake -- and 7% wouldbe better.

Keep cholesterol intake to less than 300 mg per day.

No more than one alcoholic drink per day.

No more than 1 teaspoon of salt a day.

Totally cut out trans fats if you can, but by no means consume more than 1%of total energy from trans fat.

High blood pressure is a risk factor for heart disease. Women whose bloodpressure gets to 120/80 or above should get more exercise and eat a betterdiet.

But when a woman's blood pressure reaches 140/90, Mosca says, it's time forher to talk with her doctor about blood pressure-lowering drugs.

Cholesterol is perhaps the best-known measure of heart disease risk.

Women should keep their bad LDL cholestero below 100 mg/dL. If they are atvery high risk of heart disease, Mosca says, they should talk with their doctorabout using cholesterol-lowering drugs to drop their LDL cholesterol to lessthan 70 mg/dL.

Daily Aspirin for Women?

"There is a perception that aspirin protects a woman's heart the same asa man. But that is not the case," Mosca says. "Women under 65 shouldnot be using aspirin routinely to benefit their heart -- unless they are athigh risk of heart disease."

For women under age 65, regular low-dose aspirin does reduce the risk of onekind of stroke. But aspirin also greatly increases a woman's risk of seriousbleeding. For many women, the benefit does not outweigh the risk.

"Women should consider aspirin for prevention of a certain type ofstroke -- ischemic stroke -- but that choice needs to be very informed andbased on an individual woman's risk factors for stroke and risk of sideeffects," Mosca says. "The additional benefit in women over 65 forheart attack prevention should be weighed into that decision."